Steroids
What are steroids?
Also known as corticosteroids and glucocorticoids, steroids are hormones
that are normally produced by the adrenal glands. They are mainly used in
multiple sclerosis (MS) because of their ability to decrease inflammation at
the site of new demyelisation. That ability means they can aid return to
normal function more rapidly. These steroids should not be confused with
anabolic steroids, which are sometimes used by athletes and body builders to
boost their performance.
Steroids are frequently among the first treatments used to treat acute relapses
in MS. They may also be used to help reverse inflammation and restore
vision in optic neuritis, and also to speed up recovery.
What do steroids do?
In most cases it can be expected that steroids: reduce inflammation; shorten
the duration of the relapse, and speed up recovery from a relapse. Steroids
do not reverse the outcome of a relapse. This means that whatever disability
results from a relapse, that disability will still occur irrespective of whether
treatment has been taken.
What are the side effects?
Steroids Information Sheet
November 2010
As with all drug treatments there are a number of side effects, which must be
weighed up against the positive outcomes, although, most often steroids are
well tolerated. Possible side effects may include:
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Mood changes, swings both high and low;
Difficulty sleeping/ altered sleeping pattern;
Faster than normal heartbeat (palpitations);
Weight gain (usually temporary);
Ankle swelling;
Acne (usually temporary);
Nauseousness (nausea);
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Flushing and reddening of face;
Indigestion/increased risk of stomach ulcers;
Raised blood sugars.
Long-term use is not indicated.
There is no evidence to suggest that continuous steroid administration slows
progression of MS or improves symptoms over a long period of time. The
side effects of long-term, continuous use are serious and well documented.
These include:
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Thinning of the skin;
Diabetes;
Osteoporosis;
Acne ;
Weight gain.
Since steroid use can increase your risk of developing osteoporosis, it is
beneficial to include more dairy products into your diet while on this
therapy. You could also talk with your doctor about calcium supplements
with vitamin D. If a person has had two or more courses of steroids in one
year, a bone density scan is recommended as a screen to test for
osteoporosis. Women who are post-menopausal have a much higher risk of
developing osteoporosis.
Steroids Information Sheet
November 2010
If oral steroids have been taken over a long period of time they must never
be stopped abruptly as this could lead to the suppression of the body’s own
steroid production. A tapering off of the medication dose allows body time
to normalise production.
What are pulse steroids?
These are generally monthly, one day, pulses of intravenous
methylprednisolone. This can be helpful in treating people with active MS.
Again, it is not recommended to use steroids on a regular basis or in
progressive forms of MS as studies have shown a lack of positive results.
How are steroids given?
Steroids can be given orally (usually tablet form) or intravenously (through a
drip). For those who may have difficulty swallowing, a liquid steroid can
also be used.
Any individual who experiences an acute episode (including optic neuritis),
sufficient to cause distressing symptoms or an increased limitation on
activities, should be offered a course of high dose corticosteroids. The
course should be started as soon as possible after the onset of a relapse and
should be either:
• Intravenous methylprednisolone: 500mg -1g daily for between three
and five days.
• High dose oral methylprednisolone: 500mg-2g daily for between three
and five days (oral dose is usually a gradually-reducing dose from
60mgs daily over period of three to four weeks).
How long are steroids usually taken for?
An intravenous course is given for three to five days usually. An oral course
is usually a gradually reducing dose over three to four weeks. Some courses
of steroids are given as an intravenous course first followed by an oral
course of steroids
Steroids Information Sheet
November 2010
Can steroids be taken with other medication?
A short course of steroids can be taken with most medications but if you are
unsure please check with your doctor.
What can be expected on the day of treatment?
An intravenous course of steroids is given through a drip for over one hour.
Most people experience a metal taste in the mouth when receiving
intravenous steroids, and many people take mints or sweets to counteract
this. It is advisable not to have an empty stomach prior to having your
steroids as this may induce nausea or indigestion. Some centres prescribe
tablets to prevent acid building up in the stomach when receiving steroids. In
many centres people can receive their intravenous steroids as a day case and
can go home after their drip is finished. It is important to inform the medical
team if you have diabetes before receiving steroids.
How long after receiving steroids is it ok to become pregnant?
There is little information /data on the effects of steroids on pregnancy.
Steroids have been prescribed for pregnant women who have had relapses
that have caused disability. It is not advised to take steroids during the first
8-12 weeks of pregnancy.
What is an effective time frame for steroids, and is there a
recommended next course of treatment?
Research evidence shows that there is not a large difference in rapidity
response to steroids when given three-day intravenous steroids as opposed to
for five days.
Due to the potential long-term side effects of steroids it is not advised to take
more than two courses per year, unless you are having a number of disabling
relapses. If there is a slow response from one course of steroids, another
course may be necessary.
Steroids Information Sheet
November 2010
If you have had a number of relapses where steroids were necessary over
one year then it is recommended that you either start disease-modifying
therapy or switch to a different therapy.
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Source:
This information has been taken from www.biogenidec.com.
Further Reading:
www.msactivesource.ie
www.msdecision.org.uk
Disclaimer:
MS Ireland provides information to the MS Community on an array of
topics associated with MS. This information is for reference purposes only
and medical
advice should always be sought before any treatment or intervention is tried.
Steroids Information Sheet
November 2010